ADHD and Substance Abuse in Children and Adolescents

Introduction

Attention Deficit Hyperactivity Disorder is a grave problem because children with the ADHD may develop a wide range of secondary problems. Difficulties in attention may result in poor academic achievement in schools.Impulsivity and aggression can lead to relationship issues and difficulties in making supportive peer group.Impulsivity may result in excessive risk taking behaviours with consequent complications such as substance abuse. These risk taking behaviours compromise later adjustment and give rise to many other problems (Carr, 2015)

ADHD has comorbidity with many other learning and psychiatric problems (Wilens & Spencer, 2010) However, substance abuse is the most problematic co-occurring disorders with ADHD (Wilens et al, 2011). Children with ADHD have high risk for substance abuse in their adolescence as compared to general population (Galera et al, 2013; Mochrie, et al. 2020).Van Emmerik (2012) in his international met-analysis reported that 23% of treatment-seeking young adult for substance abuse had ADHD as well. Researchers report that the risk of substance abuse is twice as high among people with ADHD (Wilens et al., 2011). Cigarette smoking is one of the important antecedents for substance abuse in ADHD adolescents. Studies have found more than half of adolescents who smoke have ADHD.Apart from tobacco, such people are at higher risk for early use of alcohol as well (Chang et al., 2012).

Previously, ADHD was thought to be only childhood disorder however, long-term controlled follow-up studies have reported that it continuing into adolescence for approximately three-quarters of cases and into adulthood for half of cases (Wilens & Spencer, 2010).

There are many studies which shows modest correlation between ADHD and substance abuse and many reasons behind such correlation has been explored. Some of the symptoms and issues in ADHD itself along with its consequences can result in substance abuse in adolescence. It is quite common that high stress levels, poor academic performance in school, lack of social support and risk taking behavior are linked with substance abuse. Apart from this, adolescents with ADHD abuse substances to attenuate their moods and to help them sleep. Risk taking behaviours along with easy availability of drugs and exposure to friend circle who abuse such drugs increase the risk of substance abuse.Studies have also reported neurobiological connection between ADHD and substance abuse. Deficits have been seen in anterior cingulate activation and the fronto-subcortical systems, in both individuals with ADHD and SUD (Casey & Jones, 2010). Furthermore, dopamine systems and striatal involvement are similar for the two disorders (Frodl, 2010). The same dopamine system is targeted in ADHD medication as well. Hence researches have been conducted to study the link between ADHD treatment by stimulant therapy and substance abuse. There are no conclusive evidence supporting that stimulant therapy can lead to substance abuse. However it is found that some abuse the same ADHD medication which further enhance their risk for other substances as well.Some other explanations for the link between ADHD and substance abuse include genetic loading and parental exposure to substance abuse. Exposure to nicotine or alcohol during pregnancy and in early developmental stages of child results in increased risk for ADHD in offspring (Zulauf, et al. 2014).

While comparing adolescents with and without ADHD, it has been found that adolescents with ADHD has higher risk for substance abuse as well as have an earlier onset and more chronic path. Kousha et al. (2012) found that adolescents with ADHD had a younger age of onset for substance abuse, a shorter period for developing a fulminate substance abuse and severe functional impairment.